Rhode Island Patient Centered Medical Home Pilot Reduces ED Visits

A Rhode Island patient centered medical home pilot program showed significant reduction in emergency dept. visits and inpatient admissions after 2 years, according to an article published online in JAMA Internal Medicine.

The pilot program’s core objective was to evaluate the effects of the pilot program of a multipayer patient-centered medical home on health care utilization and quality. The setting included five independent primary care practices and 3 private insurers in the Rhode Island Chronic Care Sustainability Initiative with patients in 5 pilot and 34 comparison practices as the participants.

The pilot analyzed multipayer claims data from 2 years before (October 1, 2006–September 30, 2008) and 2 years after (October 1, 2008–September 30, 2010). The results were measured with audit data from the National Committee for Quality Assurance patient-centered medical home recognition process.

Key finding of the pilot include:

The mean NCQA recognition scores of the pilot practices increased from 42 to 90 points of a possible 100 points.

The pilot and comparison practices had statistically indistinguishable baseline patient characteristics and practice patterns, except for higher numbers of attributed member months per year in the pilot practices (31 130 per practice vs 14 779, P = .01) and lower rates of cervical cancer screening in the comparison practices.

Although estimates of the emergency department visits and inpatient admissions of patients in the pilot practices trended toward lower utilization, the only significant difference was a lower rate of ambulatory care sensitive emergency department visits in the pilot practices.

The Chronic Care Sustainability Initiative pilot program was associated with a reduction in ambulatory care–sensitive emergency department visits of approximately 0.8 per 1000 member months or approximately 11.6% compared with the baseline rate of 6.9 for emergency department visits per 1000 member months (P = .002).

No significant improvements were found in any of the quality measures.

Overall , the improvements were not significant, but the pilot did show measurable downward trends in emergency department visits and inpatient admissions.

Launched in 2008 by the Office of the Health Insurance Commissioner, the Rhode Island Chronic Care Sustainability Initiative (CSI-RI) brings together key health care stakeholders to promote care for patients with chronic illnesses through the patient-centered medical home (PCMH) model.

Currently, over 85,000 Rhode Islanders receive their care from CSI-RI practices. Over the next five years, 20 practices will be added each year, with the goal of providing over 500,000 Rhode Islanders with access to a PCMH. CSI-RI practices were among the first in the country to be recognized as medical homes of the highest quality. The five pilot sites recently renewed their Level 3 recognition by the National Committee on Quality Assurance (NCQA), the highest obtainable recognition awarded to patient-centered medical homes